Help the patient with acute urinary retention
There are two conditions characterized by a lack of urination , - an acute urinary retention and anuria.It is necessary to distinguish them from each other, because the causes and consequences of each of them are different, and so different, and treatment strategy.
In acute urinary retention bladder is full, but it is impossible to urinate due to outflow obstruction of urine along the urethra.At the anuria bladder is empty, because urine is not produced by the kidneys or broken its entry into the bladder due to any obstruction in the upper urinary tract.Acute urinary retention in children can be caused by spasm of the sphincter of the bladder.In other cases, the child can hold the urine due to pronounced pain while urinating against a background of inflammatory processes in mocheispuskatelygom channel vulva.The causes of acute urinary retention may be urethral stone, his injury, impairment of the glans penis foreskin in boys (phimosis), as well as the disease of the central nervous system.necessary to
anuria depending on the reasons divided into arenalnuyu, prerenal, renal, and postrenal reflex.
Arenalnaya anuria observed rarely.It happens in patients in the case of congenital absence (aplasia) of the kidneys.However, it should be noted that the absence of urine in patients within the first day - a normal phenomenon, and do not need to worry.If there is no urination for more than 24 hours, then an urgent need to determine the causes.Urinary retention can be observed in a patient by developmental abnormalities such as congenital urethral valves, or in the case of adhesions in the area of its external urethral orifice.
Prerenalnaya anuria occurs when there is insufficient blood supply to the kidney or its termination.This type includes anuria in severe heart failure and vascular disease.Progressive heart failure is characterized by severe peripheral edema, fluid retention in the body cavities (ascites, hydrothorax).By vascular disease, leading to the development of anuria include thrombosis or embolism of the renal vessels, the inferior vena cava.Anuria may also occur when these vascular compression of tumor metastases.By the disorder of renal blood flow leads profuse blood loss, shock.Reduction in systolic blood pressure below 50 mm Hg.Art.Filtering causes a disturbance in the kidney.
Renal anuria cause pathological processes in the kidneys themselves.Termination of urine as a result of the disease occurs in the later stages of chronic glomerulonephritis, chronic pyelonephritis, bilateral tuberculosis and such congenital malformations as polycystic.Sometimes renal anuria occurs quickly progressing and acute glomerulonephritis.The causes of acute renal anuria may be poisoning poisons and drugs (mercuric chloride, pahikarpin, acetic acid, etc.), Transfusion of incompatible blood, extensive burns.massive crush injury to the muscles.Rarely renal anuria occurs after major surgery as a result of absorption of tissue degradation products, as well as after taking sulfa drugs (by limiting fluid intake) due to blockage or damage to the renal tubules crystals sulfonamides.
Postrenalnaya anuria occurs when there is an obstacle outflow of urine from the kidneys.The most common cause of her stones are localized in the upper urinary tract.In addition, postrenal anuria may result from compression of the ureter tumors, scars or inflammatory infiltrate in the tissue of the pelvic cavity.
Reflex anuria may be the result of the inhibitory effect of the central nervous system on urination as a result of a variety of strong stimuli (the sudden intense colds, violent instrumentation of the urinary tract), and after the operation renorenalnogo reflex (termination of the kidney after plugging stone lumen ureteral otherkidney).Symptomatic anuria manifested termination urge to urinate.After 1-3 days the absence of urine symptoms of kidney failure are developed: dry mouth, thirst, nausea, vomiting, headache, itchy skin.In the body, there is an accumulation of metabolic toxins and nitrogenous - the decay products of protein, potassium, chlorides, non-volatile organic acids.The reaction of the blood is shifted to the acid side (acidosis).Violated the water-salt metabolism.The growth of these symptoms leads to the development of weakness, drowsiness, vomiting strengthening, occurrence of diarrhea, edema, shortness of breath.Consciousness can be confused, every patient's mouth there is a smell of ammonia.The serum determined very high levels of urea and creatinine.
nature of therapeutic measures depend on the form of anuria.In patients with pre-renal anuria event emergency medical help contribute to maintaining health of the cardiovascular system.When a shock is necessary as soon as possible to achieve the restoration of normal blood pressure levels.When a large loss of blood needed urgent redress and its use of stabilizing vascular tone.With symptoms of vascular insufficiency (syncope, collapse) is administered subcutaneously caffeine, 40% glucose solution intravenously, put hot water bottles at the feet.Patients in serious condition for continuation of treatment are hospitalized in the intensive care unit.When renal anuria caused by poisoning poisons, acute renal failure due to renal disease, requires immediate hospitalization in a hospital where there is a device for peritoneal dialysis or hemodialysis.At the anuria postrenal the main type of treatment is prompt, so the patient is hospitalized in urology or surgery department, where you can spend the extra examination and removal of the cause of the violation of the outflow of urine.
Foreign bodies of the bladder and urethra are rare.Symptoms of bladder foreign body are pain in the lower abdomen, radiating to the external genitalia, frequent painful urination, discharge of blood and pus in the urine.All these symptoms are worse when moving.There may be a intermittent stream of urine, and sometimes develop acute urinary retention.The diagnosis is confirmed by ultrasound, X-ray studies or instrumental examination of the bladder (cystoscopy).With the penetration of a foreign body in the lumen of the urethra there is pain, which becomes stronger when urinating.Urination difficult, painful, can occur acute urinary retention.Purulent process development in the urethra can lead to bleeding.Foreign body from it must not be removed in an outpatient setting, as this channel is easily damaged.The patient is administered antibakteriaalnye and painkillers, and then admitted to the hospital for emergency specialist care.